Poor Immune System

Iron Deficient Anemia

High White Blood Cell Count & Low Blood Pressure

At some point in time, for some duration of time, people with tumor conditions like neurofibromatosis type II (NF2) are at risk of a poor immune system and, with it, iron deficient anemia. Different health situations can result in low hemoglobin levels.

The contents here explain what this might mean to people with NF2 and iron-deficient anemia, including symptoms, reasons for proper diagnosis, and management options in both food and vitamin form.

Iron-deficient anemia caused by tumor growth is not always a permanent health issue. It can be a temporary issue that lasts a few months during recovery from a severe treatment.

1. What is Iron Deficient Anemia?

The most common type of anemia in the general American population is Iron deficiency anemia, simply a result of insufficient iron-rich foods in the typical American diet. It can also result from health issues that lower the absorption rate of iron absorption from food, or an individual may require more iron than the average diet due to health-related blood issues. Some of the reasons for this would be from a person:

1. experiencing Blood Loss,
   • bloody loss could even be minimal like bleeding gums or minor nose bleeds
   • after surgery
   • women from blood loss during monthly periods and childbirth
2. Over 65 who are more likely to have diets that are low in iron
3. taking Blood Thinners
4. have Kidney Failure (especially if they are on dialysis) because they have trouble making red blood cells
5. have trouble absorbing iron

Iron-deficient anemia commonly occurs after surgery during the healing process, particularly following brain surgery. It could also be the result of specific tumor growth, congestive heart failure, or inflammatory diseases.

Iron deficiency anemia can appear like Raynaud's disease.

2. Symptoms

If you have Iron Deficient Anemia you may experience some of the following:

• Extreme tiredness (Fatigue)
• Constipation
• Headaches, Dizziness, Lightheadedness or Feeling Faint
• Weakness
• Anxiety
• Depression
• Chest pain, Palpitations, Fast or Irregular heartbeat
• Shortness of Breath
• Trouble breathing when doing things like walking, climbing stairs, or even talking
• Swelling or cold hands and feet
• Pale or yellow skin, nail beds, mouth, and gums
• Inflammation or soreness of the tongue
• Brittle Nails
• Unusual cravings for non-nutritive substances, such as ice, dirt, or starch
• Poor appetite, especially in infants and children with iron deficiency anemia
• Twitching muscles
• Dysphagia (Difficulty Swallowing

3. Diagnosis by Doctor - In Office Visit

Iron Deficient Anemia, might be seen in blood tests as; High White Blood Cell Count, or Low Platelet Count, but more specifically a low Mean Corpuscular Hemoglobin Concentration (MCHC), it can also result in Low Blood Pressure Hemoglobin is a protein in red blood cells that carries oxygen from the lungs to all parts of the body necessary for the brain and organs.

It is dangerous for an individual to determine if they do or do not have Iron Deficient Anemia on their own based on symptoms and personal review of blood test, this is something a doctor needs to do in an in-office visit. Confirmation of Anemia is based not just on White Blood Cells or Platelets, but Complete Blood Count (CBC) and additional factors. The options of what to do for best options for each person is different depending on the situation and self-management can be not just dangerous but life threatening.

1. Prescriptions, Treatments and Chemotherapies might require adjustments such as breaks or temporarily taking lower doses.
2. How much iron is needed, depends on many factors, and only a small amount in diet may correct the situation. However, iron is not a substance the body will pass if more than is needed is consumed.
3. The amount of iron assumed to be necessary may not be enough. After attempts at adjustments, patients may require more iron than food or supplements can deliver, and a blood transfer may be necessary.
4. High Hemoglobin levels from over-consumption of Iron in food or supplements can cause kidney or other organs. A yearly or more frequent blood test may be required to monitor organs.
5. Symptoms and numbers in blood work can be the result of something else.
6. Anemia is best treated when the actual reason for its development is found, which is best done with the help of a doctor.

The amount of iron an individual needs each day typically depends on age, sex, and whether a plant-based diet is consumed. A person with Iron-Deficient Anemia due to poor iron absorption or a health issue will require more iron than the listed numbers. Talk to your doctor.

4. Management Options

Management of Iron Deficient Anemia may require a combination of an increase of foods high in Iron, an Iron Supplement (Ferrous Sulfate), Vitamin B12 and/or Folic Acid. Depending on the situation supplements alone may not be enough and require a blood transfusion.

Hemoglobin iron is commonly referred to as Heme Iron. Heme-Iron is found in animal foods that originally contained hemoglobin, such as red meats, fish, and poultry meat. Poultry, and seafood contain both heme and non-heme iron. Your body absorbs the most iron from heme sources. Most Non-Heme Iron is from plant sources.

Iron rich foods fall under two categories; heme (from animal sources) and non-heme (from plants). Iron rich foods from animal sources can help reach iron levels faster and stay in the body longer. Plant based iron rich foods have many additional health benefits, despite the need of more to maintain the same amount of Hemoglobin in the blood. Remember that Iron Deficient Anemia causing fatigue and poor appetite, which means eating until full is not necessarily enough.

5. Iron Rich Food

Listed in the first two sections are foods highest in iron, but does not include the whole list of foods that also include iron.

Hemoglobin Iron also known as Heme Iron (from animal sources)

• Beef (Chuck, Roast, Lean, Ground or Liver)
• Chicken Liver
• Clams
• Leg of Lamb
• Oysters
• Shrimp
• Salmon
• Tuna
• Turkey Leg

Non-Hemoglobin Iron also known as Non-Heme Iron (from plants)

• Beans (Kidney, Lima, Navy)
• Brown Rice
• Lentils
• Molasses
• Multigrain Bread
• Oatmeal
• Peanut butter
• Raisin bran (enriched)
• Spinach
• Whole Wheat Bread

General Iron Food Explanation

• Lean meat, seafood, and poultry.
• Iron-fortified breakfast cereals and breads.
• White beans, lentils, spinach, kidney beans, and peas.
• Nuts and some dried fruits, such as raisins.

6. Absorption

Increase Absorption

It can be harder to reach iron goals with non-heme irons, but the following can help without requiring a large quality of food to meet goals:

1. Eating some heme iron with other sources of non-heme iron makes the iron more wholly absorbed.
2. Food with iron can have a higher rate of absorption if eaten along with a good source of vitamin C. Sources of Vitamin C include; orange juice, broccoli, strawberries, tomatoes, citrus fruits like strawberries, red peppers, yellow peppers and orange peppers, or eat non heme iron foods with a food from the meat, fish, and poultry group.

Iron (Heme) Inhibitors

Be it heme or non-heme certain foods can lower chances of not just meeting goals and resulting in issues. However, the body will be able to obtain proper ion availability 2 hours after digestion, or a higher amount of iron rich foods would be required if eaten in combination of these thing.

Foods that can lower absorption include: (Polyphenols) Coffee, black tea, calcium rich foods, eggs, walnuts, fruits such as apples, blackberries, raspberries and blueberries.

7. Sources

1. Mayo Clinic. "Raynaud's disease" (2024) Source: https://www.mayoclinic.org/diseases-conditions/raynauds-disease/symptoms-causes/syc-20363571
2. American Cancer Society. "Anemia in People With Cancer." (2016)
   Source: http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/anemia/anemia-in-people-with-cancer
3. Mayo Clinic. "Iron Deficient Anemia." (2016)
   Source: http://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/dxc-20266514
4. National Institute of Health. "Iron." (2016)
   Source: https://ods.od.nih.gov/factsheets/Iron-Consumer
5. WebMD. "Iron-Rich Foods." (Last Reviewed: 11-19-19)
   Source: http://www.webmd.com/diet/iron-rich-foods
6. Cleveland Clinic. "Anemia and Iron Rich Foods." (Last Reviewed: 10/26/2017) Source: http://my.clevelandclinic.org/health/diseases_conditions/hic_Anemia/hic-anemia-and-iron-rich-foods
7. Medscape. "Iron Deficiency Anemia Workup." (Updated: Sep 07, 2019)
   Source: http://emedicine.medscape.com/article/202333-workup
8. Gonzalez, Hugo, Catharina Hagerling, and Zena Werb. "Roles of the immune system in cancer: from tumor initiation to metastatic progression." Genes & development 32.19-20 (2018): 1267-1284. DOI: 10.1101/gad.314617.118. | https://www.ncbi.nlm.nih.gov/pubmed/30275043